Enterotoxigenic Escherichia coli Type O6-related Cytoplasmic Anti-neutrophil Cytoplasmic Antibody-positive Necrotizing Glomerulitis Diagnosed by Indirect Immunofluorescence

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Two days after eating beef steak grilled rare, a 28-year-old man developed a fever, abdominal pain, and diarrhea. The diarrhea resolved after 5 days of ciprofloxacin treatment (200 mg). Stool cultures obtained at the time of the onset were subsequently confirmed as enterotoxigenic Escherichia coli type O6. However, the renal dysfunction worsened, and the patient developed proteinuria and urinary occult blood. A kidney biopsy revealed necrotizing glomerulonephritis in the majority of glomeruli. An enzyme-linked immunosorbent assay was negative for myeloperoxidase/proteinase 3 anti-neutrophil cytoplasmic antibody (ANCA), but indirect immunofluorescence (IIF) was positive for cytoplasmic ANCA (C-ANCA). This case suggests a relationship between necrotizing glomerulonephritis and IIF-positive C-ANCAs.

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